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Blood pressure FRUSTRATION>>>>>>
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 2009-08-28 10:50 AM |
 Subject: Blood pressure FRUSTRATION>>>>>>Posted a couple weeks ago, I had started on lisinopril to control what has always been borderline high blood pressure. I started taking coumadin and it seemed that caused my BP to be more consistently high and (for other reasons as well) decided to medicate it. Take BP twice a day with an Omron Started at 5mg (low, I know, but I want to take as little as possible). No effect... 10... no effect.... 20... no effect. Sometimes would be 130. Sometimes 150+. Called my doc, she said continue 20 and call me in a month. I was very frustrated, I told her didn't know why we weren't being more aggressive. She wanted to send me back to the cardiologist (i.e., pass the buck), started talking about adding a diuretic (which I quashed) but I convinced her to try 20 2X day. So we went to that. Been on 40 for two days. Still stayed in the 130-140 range for the most part, but last night after I got home from swimming it was 117 or so (it's always low after swimming, and can't really take it before). So I thought maybe we're moving in the right direction. This morning... 162. F***!!!!!!!! Just thinking about it raises my BP. I know there are lifestyle issues. I can stand to lose 20#. I need to start exercising regularly again. But still. A month on lisinopril and up to 40/day, and the BP is going UP. Really more of a vent/rant, but it was a big deal for me to even go on the meds, and to have them not work is so frustrating it's unbelievable. Not asking for specific med. advice, but if anyone has ideas, or something else to bring to the doc, I am all ears. As an aside, I've come to the conclusion that I am switching docs anyway, but kinda wanted to get this issue under control before I did do...... Edited by ChrisM 2009-08-28 10:52 AM |
| 2009-08-28 10:55 AM in reply to: #2376334 |
Champion  8936      | Subject: RE: Blood pressure FRUSTRATION>>>>>> What BP did you start at, Chris? If it hasn't moved at all, I would ask to switch meds. ACE inhibitors are great, but for some reason, some meds just don't work well for some people. You're not on max dose yet, but there's a point of dimishing returns with the higher doses. Might be worth switching it out completely with something else rather than adding something on. |
| 2009-08-28 11:06 AM in reply to: #2376353 |
| Subject: RE: Blood pressure FRUSTRATION>>>>>> It varied, but the variations were smaller than they are now. I kept a log but gave it to the doc, but varied generally between 120 up to 140s, most commonly in the 130s-140s. But never saw a 150+. So in essence the high end has gone up. I also have some shortness of breath from the PEs and some lung infarction, so wonder if that has anything to do with it (not to mention going from 10-12 hours a week of exercise to 2-3 or so, and adding about 15#)........ Edited by ChrisM 2009-08-28 11:07 AM |
| 2009-08-28 11:43 AM in reply to: #2376334 |
Champion 6656 | Subject: RE: Blood pressure FRUSTRATION>>>>>> This is direct from one of my texts "Pathophysiologic mechanisms with acute stress and intense emotion lead to sympathetic nervous system stimulation with an increase in heart rate and blood pressure, vasoconstriction, proarrhythmic potential, reduced endothelial dysfunction, endothelial injury, platelet activation, and/or hemostatic changes; all of the foregoing have the following clinical consequences: myocardial ischemia, arrhythmias, and the potential for thrombosis." Just something to think about. I have difficulty not letting my frustrations affect me as well, but as you said "Just thinking about it raises my BP." and it does... There are a large number of different antihypertensive agents...alpha/beta blockers, diuretics, central agents (drugs that have their primary site of action in the brain), calcium channel blockers, angiotensin II receptor blockers (losartan, valsartan) and then vasodialators (arterial--minoxidil, hydralazine, arterial and venous--nitroprusside)...The "best" choices are the angiotensin II receptor blockers, diuretics and perhaps vasodilators....the other classes of drugs have widespread effects systematically and therefore, there is a more significant chance of side effects. |
| 2009-08-28 12:15 PM in reply to: #2376334 |
| Subject: RE: Blood pressure FRUSTRATION>>>>>> I appreciate the input. I have other reasons for not liking my GP right now so those are probably coloring my response to her. My biggest concern is that I would have to use diuretics. I am coming off a thrombosis and anti coagulated (hence my intense focus on the BP) and I believe that a large factor in the clots was dehydration during and after a race followed by a long car ride. I am recovering but I am working on staying hydrated, I just don't want to make it that much harder on my body. Don't want to have to choose between another clot and hi BP  |
| 2009-08-28 2:19 PM in reply to: #2376489 |
Expert 763 Behind you | Subject: RE: Blood pressure FRUSTRATION>>>>>> mndymond - 2009-08-28 12:43 PM I'm just listing these to give you some hope that there are other options and a possible reason for why lisinopril isn't working for you. I wouldn't necessarily view her suggestion to go to a cardiologist as "passing the buck". GP's are a primary stop to access what is wrong and it is possible that further management of your hypertension is beyond what she is able to help you with and that going to see a specialist might give you more options? ....Doctors in general don't know EVERYTHING, but a cardiologist might be better able to help you manage your hypertension. Very well said. Meds work good for some, and can do nothing for others. |
| 2009-08-28 7:48 PM in reply to: #2376334 |
Extreme Veteran 1996 Halifax, Nova Scotia | Subject: RE: Blood pressure FRUSTRATION>>>>>> I would exhaust all reasonable ACE inhibitor possibilities (assuming you have good renal function) before I move to the Beta blocker option. The Beta's will impair your exercise tolerance much more, particularly if its currently good (or better). |
| 2009-08-28 9:19 PM in reply to: #2376334 |
Member 44 Abingdon, MD | Subject: RE: Blood pressure FRUSTRATION>>>>>> Hi Chris- I just wanted to post to let you know I understand your frustration with this. The PE/ infarctions may be a part of the problem but the history that you already had borderline high blood pressure before makes me think you may be really, really stressed over all this stuff which is making your pressure worse. My blood pressure shot through the roof last June (2008) about 2 months after my son was diagnosed with a serious illness, underwent surgery and radiation (he's doing really well now). I also ended up on lisinopril. Like you, I had put on 15-20 lbs and still trying to get rid of it to this day The good news is I was able to stop the lisinopril in May but that was after a year of treatment. I've found that the physical activity has made a much larger difference in reducing my blood pressure than changes in my diet.I also was sent to a cardiologist, endocrinologist and hematologist (won't get into all of that but it was all related). I found out alot of stuff that I wouldn't have known for yrs (like thyroid problems) that could have caused serious problems down the road. I would definitely recommend seeing the cardiologist. Just curious- what does your diastolic run (the lower #)? |
| 2009-08-29 11:50 PM in reply to: #2376334 |
| Subject: RE: Blood pressure FRUSTRATION>>>>>> Diastolic is consistently hi 70s - lo 80s. The occasional jump to 90 but rare |
| 2009-08-30 8:05 AM in reply to: #2376334 |
Member 44 Abingdon, MD | Subject: RE: Blood pressure FRUSTRATION>>>>>> That's a decent diastolic which tends to be the # your dr is going to be more worried about short term. I'm not saying the systolic doesn't matter, but the diastolic is the resting pressure in your vessels. Please see the cardiologist!! He/she will be able to put everything in perspective for you and I'm willing to bet you could be off of the medication over the next 6 months to a year. Even if you ended up having to stay on some medication, it would probably be a much smaller dose. If you're currently on 20 mg twice a day of lisinopril, it's maxed. Good luck!! Keep me posted- jen |
| 2009-08-30 8:11 AM in reply to: #2376334 |
Champion 8936 | Subject: RE: Blood pressure FRUSTRATION>>>>>> jgoldsbo - 2009-08-30 8:03 AM That's a decent diastolic which tends to be the # your dr is going to be more worried about short term. I'm not saying the systolic doesn't matter, but the diastolic is the resting pressure in your vessels. Please see the cardiologist!! He/she will be able to put everything in perspective for you and I'm willing to bet you could be off of the medication over the next 6 months to a year. Even if you ended up having to stay on some medication, it would probably be a much smaller dose. If you're currently on 20 mg twice a day of lisinopril, it's maxed. Good luck!! Keep me posted- jen Ok, I'll be the contrarian physician as usual. No difference in systolic hypertension and diastolic hypertension. Equally important. You go with the higher number (relative to normal) and treat that. I don't think a cardiologist is necessary to treat hypertension. It's a "bread and butter" problem dealt with by primary care physicians every day. I only refer to them when 3-4 medications aren't doing the job, and that's a rarity. They generally don't offer much at that point either and most admit that. Some people just have difficult to control BP. Chris has a long ways to go in terms of adjusting meds before that would even be a concern. The max dose of lisinopril is 40mg twice daily. |
| 2009-08-30 9:02 AM in reply to: #2376334 |
Pro 4827 Plano, Texas | Subject: RE: Blood pressure FRUSTRATION>>>>>> I've been dealing with BP for the last 3+ years. Started out 189 lbs (2 biscuits away from 200). Went to a doctor for the "I'm coming up on 40 with a family history of heart disease" check up. BP was 145/100 avg at that time. Dr immediately started talking drugs. I'm resistant - let's try all avenues first. Course of actions: 1. started running (which led to triathlons) 2. monitoring (and recording) everything I ate for weight loss 3. monitoring (and recording) everything I ate for sodium 4. limiting the amount of caffeine (coffee & chocolate). Eventually I ended up on Benicar (worked great for me). But after 3 months, I talked to the dr again and stopped taking it. I'm now controlling and maintaining at an average of 121/78 without meds. Biggest single factor (for me) according to my experiments is exercise. I HAVE to exercise >40 minutes / day for >4 times a week to maintain OR completely remove myself from the day to day stressors of life (ie vacation). |
| 2009-08-30 8:12 PM in reply to: #2378624 |
Member 44 Abingdon, MD | Subject: RE: Blood pressure FRUSTRATION>>>>>> DerekL - 2009-08-30 8:11 AM jgoldsbo - 2009-08-30 8:03 AM That's a decent diastolic which tends to be the # your dr is going to be more worried about short term. I'm not saying the systolic doesn't matter, but the diastolic is the resting pressure in your vessels. Please see the cardiologist!! He/she will be able to put everything in perspective for you and I'm willing to bet you could be off of the medication over the next 6 months to a year. Ok, I'll be the contrarian physician as usual. No difference in systolic hypertension and diastolic hypertension. Equally important. You go with the higher number (relative to normal) and treat that. I don't think a cardiologist is necessary to treat hypertension. It's a "bread and butter" problem dealt with by primary care physicians every day. I only refer to them when 3-4 medications aren't doing the job, and that's a rarity. They generally don't offer much at that point either and most admit that. Some people just have difficult to control BP. Chris has a long ways to go in terms of adjusting meds before that would even be a concern. The max dose of lisinopril is 40mg twice daily.Even if you ended up having to stay on some medication, it would probably be a much smaller dose. If you're currently on 20 mg twice a day of lisinopril, it's maxed. Good luck!! Keep me posted- jen You can be contrarion. I like contrarion!! My best friends are contrarion. I'll explain myself-- I'm a nurse practitioner. Most of the docs I've worked with won't go over 40 mg lisinopril a day since they don't believe it has much more of an effect. Like you, they aren't quick to refer to cardiology for hypertension and neither am I. However in the case of a fairly young guy with recent history of PE and who wants to be pretty active, I would be quicker to consider it. I actually argued with my GP when they wanted to send me because I didn't see the need to go. Now, I'm so glad I listened- um I mean got forced- to go. Hope that explains my thought processes a little better-- jen Edited by jgoldsbo 2009-08-30 8:28 PM |
| 2009-08-31 1:25 PM in reply to: #2376334 |
| Subject: RE: Blood pressure FRUSTRATION>>>>>> Appreciate all the input. And a follow up question. As mentioned, I use an Omron BP machine. Often it wull vary greatly between arms and also between times. My doc always said record the highest if I take multiple, which seems to make sense. But this a.m., for example it was left arm 152/78, immediately after right arm 125/79. waited 5 minutes, left arm again 133/78. How do you tell what your BP really is? |
| 2009-08-31 1:41 PM in reply to: #2380763 |
Pro 4827 Plano, Texas | Subject: RE: Blood pressure FRUSTRATION>>>>>> ChrisM - 2009-08-31 1:25 PM Appreciate all the input. And a follow up question. As mentioned, I use an Omron BP machine. Often it wull vary greatly between arms and also between times. My doc always said record the highest if I take multiple, which seems to make sense. But this a.m., for example it was left arm 152/78, immediately after right arm 125/79. waited 5 minutes, left arm again 133/78. How do you tell what your BP really is? I would take your machine to the local firestation. Ask them to take your BP. Then take it yourself with your machine. |
| 2009-08-31 1:44 PM in reply to: #2380804 |
| Subject: RE: Blood pressure FRUSTRATION>>>>>> KenD - 2009-08-31 11:41 AM ChrisM - 2009-08-31 1:25 PM Appreciate all the input. And a follow up question. As mentioned, I use an Omron BP machine. Often it wull vary greatly between arms and also between times. My doc always said record the highest if I take multiple, which seems to make sense. But this a.m., for example it was left arm 152/78, immediately after right arm 125/79. waited 5 minutes, left arm again 133/78. How do you tell what your BP really is? I would take your machine to the local firestation. Ask them to take your BP. Then take it yourself with your machine. I actually did that with my doc about a month ago, we both got the same readings |
| 2009-09-08 6:27 PM in reply to: #2376334 |
| Subject: RE: Blood pressure FRUSTRATION>>>>>> Just as an update... not sure if it was a different manufacturer of meds (larger white ones vs. smaller pink ones, but supposedly all 20 mg), my change of diet (cut out gluten and most all sugar and dairy) or acupuncture... but all of a sudden 4 days ago it now reads a more or less consistent 110/75 with a few outliers (inlcuding one 98/70)....... Hard to tell which helped (maybe all) since I started all at about the same time. Edited by ChrisM 2009-09-08 6:28 PM |
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